Robert D Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2021 Issued in LA

Practice address

611 Saint Landry St
Lafayette, LA 70506-4627

Phone

(337) 289-2966

Fax

(337) 289-2776

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS Burleigh, Dupleix and Rees

  • Anesthesiology Physician
  • Lafayette, LA
  • NPI 1659368694
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1720198922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53864",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705053864",
            "telephone_number": "337-289-2966",
            "fax_number": "337-289-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SAINT LANDRY ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705064627",
            "telephone_number": "337-289-2966",
            "fax_number": "337-289-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "2021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1393185",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clark Integrated Medical Clinics LLC
• Christina Marie Clark Mills, PHYSICAL THERAPIST
• Aja Clark
• Cassie Clark
• Jacob Scott Clark, D.C.
• Roderick V. Clark, M.D.
• Ross Clark
• Andrew F. Clarke, M.D.
• Fran F Clarke, LCSW BCD
• Lizabeth F Clarke, MD

• All providers in Lafayette, LA
• Certified Registered Nurse Anesthetist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.